Clinical Spine Fellow Banner University Medical Center Phoenix, Arizona, United States
Introduction: Total hip arthroplasty (THA) is a common procedure in US with over 300,000 cases per year. Leg-length is a measurement that must be considered when performing this procedure since leg-length discrepancy can lead to lumbar scoliosis. We sought to evaluate the effect of THA on scoliosis, as well as other lumbopelvic measurements
Methods: PubMed, Medline, EMBASE, and Google Scholar were searched with the keywords “total hip arthroplasty”, “scoliosis”, “hip surgery”, “spine coronal alignment”, and “spinal alignment” with Boolean operators to provide appropriate returns. Articles were screened for relevance based on titles and abstracts. Exclusion criteria included pediatric populations, cerebral palsy, muscular dystrophy, and other developmental disorders. The remaining articles were further evaluated for lumbopelvic measurements before and after THA. Measurements of lumbar cobb angle, lumbar lordosis, leg-length discrepancy, and back pain were evaluated
Results: A total of 281 articles were screened and 28 were included for full review. Only 3 articles had pre- and postoperative measurements of lumbar cobb angles/scoliosis. They demonstrated that the average change in Cobb angle was an improvement from 8.3 +/- 3.9 to 6.1 +/- 3.1, with two of the three studies having a statistically significant result. The most common measurement found was lumbar lordosis, which was included in 10 of the 28 studies. Six of those studies had a decrease in lordosis with an average of 52.0 +/- 6.8 to 49.5 +/- 7.0; however, the other 4 studies had increase in lordosis with an average of 48.0 +/- 9.1 to 52.5 +/- 10.7. The only other measurement of our criteria reported was back pain via the Visual Analog Scale (VAS) and only 1 study had a significant decrease in VAS with a change of 22.8 +/- 4.7 to 9.35 +/- 3.3. Thirteen studies did not have any measurements relevant to our search.
Conclusion : Hip and lumbar pathology are intimately related. Lumbar deformity parameters can improve or worsen after hip arthroplasty. This work highlights the importance of close radiographic and clinical surveillance of patients with lumbar disease after total hip arthroplasty.
